We found that combining the ALPK1[R153A] mutation with the spiradenoma mutant (Fig. 4C) or the ROSAH mutant (Fig. 4D) did indeed prevent activation by UDP-α-D-mannose, GDP-α-D-mannose, ADP-D-ribose, cyclic ADP-D-ribose, and UDP-α-D-galactose in vitro. The gene discussed is ALPK1; the disease is benign spiradenoma.